By Dr. Anthony Policastro

The United States has the 9th highest death rate in the world from COVID-19. That means that 186 other countries have done a better job of handling it than we have.

There are many factors involved. However, one of the biggest is the continued denial by many that the pandemic is a real issue.

There are multiple reasons for that attitude. However, one of them is a psychological term called identity fusion.

The best example of this is related to sports fans. There are some die hard fans that are very intertwined with their team psychologically.

That is why there are riots after soccer games in Europe.

Another example is the rise of ISIS. We often heard about people being radicalized. That is a simple way of saying that these individuals developed identity fusion with the philosophy.

We have seen a similar thing occur in the United States related to the pandemic. COVID-19 is dangerous. There are a lot of restrictions associated with it. Therefore, anything that lessens its seriousness feeds into denial of that seriousness.

Thus when someone has identity fusion with a political figure like Donald Trump, their denial allows them to believe anything that would lessen that seriousness.

If he says it is a hoax, that is to be believed. If he says that it will go away, that is to be believed. If he says don’t wear a mask, that is to be believed. If he says hydroxychloroquine is a magic cure, that is to be believed. If he says we are rounding the corner, that is to be believed.

The combination of denial and identity fusion allows this to happen. It does not make the individuals belittling the disease correct. It does not make them less smart. It is just their way of coping psychologically with bad news.

We sometimes wonder how people can believe these outlandish statements in light of the facts staring them in the face.

It is not really a surprise. They are thinking at an emotional level. They are not thinking at a logical level. They are wrong but will never really know it.

COVID-19 update

Total number of new cases nationwide surpassed 1 million last week for the first time. However, there seemed to be some steadying of numbers over the last few days. It is likely that the 1 million mark will be the norm for the foreseeable future.

Sussex County realized just about 500 new cases last week. That was after being at about 350 new cases for the previous two weeks. That is still not as high as the 1,341 cases in a 13-day period in May.

Sussex County doubled its number of new cases last week. The last time it doubled it took 38 days. This time it took 128 days. That is significantly longer than the last US doubling at 88 days.

It is significantly longer than the last Delaware doubling at 87 days. So locally, we continue to do well from a relative standpoint.

We have heard a lot about the term herd immunity. This is the concept that is used for childhood immunizations. If enough children are immunized against a disease, the infection will have a hard time finding non-immunized individuals to infect. Therefore, it will not run rampant.

Some people have been pushing the concept of herd immunity as the best approach to COVID-19.

To reach ‘herd immunity’ about 70 percent of the population must be protected. It can occur through immunizations. It can occur through natural infections.

With a population of 330 million, we need about 230 million people protected in order for that to work.

So far we are over 10 million cases. (The actual number of total cases is likely significantly higher than that since there are many mild cases that don’t get tested.) That still leaves us with 220 million to go.

Recently we have been close to 1 million new cases per week. That means that if we let the virus percolate, it would take an additional 220 weeks (over 4 years) to reach the point of herd immunity. That is why a vaccine makes so much more sense.

The primary mode of transmission of COVID-19 is by someone with the virus on their hands touching their face.

For that reason, the primary reason for wearing masks has been to keep infected individuals from transmitting the virus to the hands of unaffected individuals.

Logic would suggest that there is some benefit to the uninfected individual as well. The CDC came out with a statement confirming that last week. Wearing a mask does offer protection to uninfected individuals. Not much of a surprise in that announcement.

When President Trump was hospitalized, he received artificial antibody treatment. The antibody was manufactured by a company called Regeneron. Last week emergency authorization use was given to another antibody drug manufactured by Eli Lilly. The name of the drug is bamlanivimab (try saying that fast three times). The authorization was for the drug to be used in patients in the early stages of COVID-19 disease.

It is given by IV infusion. The use is not authorized for patients already in the hospital. It is not authorized for those already on oxygen therapy.

The reason for that is that it has not been shown to be of benefit to hospitalized patients. It is to be used according to the product insert: “for the treatment of mild to moderate COVID-19.”

The focus is giving it to patients who are at high risk for hospitalization. The criteria include obesity, chronic kidney disease, diabetes, immunosuppression or age over 65 years. It is authorized for use in individuals over age 12.

They are measuring two main things about its effectiveness. The first is the amount of viral load that the patients have 11 days after baseline.

We already know that higher viral loads are associated with more severe disease. Viral loads tend to remain high for about three weeks. Therefore, checking them at 11 days is reasonable.

The second criterion is how many patients go on to require hospitalization and/or die.

As expected with any new drug, there are some words of caution. The first is that this is still a Phase II study. There are a total of 1,200 participants included. About half of those received placebo.

So far there have not been significant side effects. However, with the small numbers, that doesn’t mean much.

There is also a production issue. Lilly hopes to have a million doses available worldwide by the end of 2020. The U.S. alone is coming close to averaging that many new cases per week. Therefore, availability is liable to be initially limited.

The big news last week on the vaccine front was from Pfizer. They announced that their vaccine proved to be 90 percent effective. They had enrolled 43,538 volunteers to test the vaccine.

Participants had 94 confirmed cases of COVID-19 infection. When they compared cases in vaccine vs placebo groups, they determined that the vaccine was 90 percent effective. The plan is to continue the study until they reach 164 confirmed cases of COVID-19.

The news is promising. We do need to remember that the number of individuals in the test was small. The number of infected cases was small. The hope is that the statistics hold up as they wait to get up to the 164 confirmed cases point. Pfizer hopes to produce 50 million doses this year and 1.8 billion next year.

Another thing to consider is the safety issue. Their initial report was that there were few safety concerns. The main side effects were significant pain at the injection site, fatigue and fever. They lasted for several days.

The problem is that about half of the 43,538 patients would have been given the vaccine. Therefore, if there is a rare side effect that occurs less than 1 in 20,000 doses, it might not show up yet.

You may remember my swine flu article. The Guillain Barre paralysis that occurred with that vaccine was one for every 100,000 individuals.

You also might remember the article that I published on anamnestic response a few months ago. The point of that was that we still have the ability to make antibodies after an infection even if none can be detected in the blood stream.

Now a new study from Italy looked at that. They found that after infection 77 percent of the infected individuals had antibodies. However, if they looked for an anamnestic response, 97 percent of the individuals showed that.

Bottom line is that even if you cannot measure antibodies after the illness, it doesn’t mean you cannot make them.